VBS Form

VBS Registration Form

Please fill out the form below for submission of your child's participation. This year, VBS will be held at the Resurrected Baptist Church; address shown below. If you have any questions or concerns, please contact us at (423) 698-8086.
Monday, June 15th - 19th 6:00-8:30pm

Resurrected Baptist Church - 4501 Oakhill Drive, Chattanooga, TN 37416
- Participant Name*
  
  First NameLast Name
- Age*
- Date of Birth*
  
  MonthDayYear
- Grade
- Medical Problems/ Allergies / Special Needs*
- Parent / Guardian's Name*
  
  First NameLast Name
- Phone Number (Daytime / Emergency)*
  Format: (000) 000-0000.
- Phone Number (Evening)
  Format: (000) 000-0000.
- E-mail*
  example@example.com
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip CodeCountry
- Do you currently have a home church?
  
  YesNo
- If Yes, where?
- Tell us how you learned about VBS at Resurrected Baptist Church:
  
  RBC WebsiteInternetNewspaperFlyer / PosterRBC MemberInvited by a friend
- CONSENT FOR MEDICAL TREATMENT | As the parent or legal guardian of the above-named participant, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of my dependent.
- By signing and submitting this registraiton form, you understand and agree to all policies.
- Parent/Guardian Signature*
  
  First NameLast Name
- Today's Date*
  
  MonthDayYear
  Date
- Comments and/or Questions:
- Should be Empty:

VBS Registration Form

Monday, June 15th - 19th 6:00-8:30pm